International Notes
Update: Human Plague -- India, 1994
During August 26-October 5, 1994, a total of 5150 suspected
pneumonic or bubonic plague cases and 53 deaths were reported from
eight states of India, primarily in the south-central and
southwestern regions. Of the 5150 cases, 2793 (54.2%) were reported
from Maharashtra state (including Bombay), 1391 (27.0%) from
Gujarat state (including the city of Surat), 749 (14.5%) from
Delhi, and 169 (3.3%) from the states of Andhar Pradesh, Haryana,
Madhya Pradesh, Rajasthan, Uttar Pradesh, and West Bengal
(including Calcutta). As of October 5, a total of 167 (3.2%) of
these cases were confirmed by serology. Confirmed cases were
reported from Delhi (44 cases); Gujarat (35 cases); Maharashtra (79
cases); and Haryana, Madhya Pradesh, and Uttar Pradesh (9 cases).
Of the 53 deaths (crude case-fatality ratio=1.0%), 49 (92.5%) were
reported from Surat.
As of October 5, no imported plague cases have been detected
in other countries. No plague cases have been reported in U.S.
residents in India.
Reported by: World Health Organization, Geneva. Div of Quarantine,
National Center for Prevention Svcs; Bacterial Zoonoses Br, Div of
Vector-Borne Infectious Diseases, National Center for Infectious
Diseases, CDC.
Editorial Note
Editorial Note: During 1970-1991, 296 laboratory-confirmed plague
cases (295 indigenously acquired and one imported) were reported in
the United States, with a case-fatality ratio of 14.5% (1).
Reliable data about the plague outbreaks in India are unavailable,
and case criteria have not been described. However, the low
reported crude case-fatality ratio suggests that 1) many suspected
plague cases were not true cases, 2) deaths were underreported, or
3) antibiotic treatment was administered promptly in virtually all
cases.
Travelers to India and other plague-endemic countries are at
low risk for infection with Yersinia pestis. Because of the
potential for importation of plague into the United States, CDC has
intensified surveillance at international ports of entry. Under a
protocol implemented by CDC, the Immigration and Naturalization
Service, and the U.S. Customs Service, persons traveling by air
from India to the United States are now being provided written
information about the symptoms of plague and the need to seek
prompt medical attention if symptoms occur. Under international
health regulations (2), air passengers who have an illness
suspected to be plague (i.e., based on clinical presentation and
travel history) during a flight or at disembarkation are subject to
isolation and transfer to an appropriate diagnostic and treatment
facility. As of October 5, CDC has evaluated for plague three air
passengers who disembarked in the United States; none was found to
have plague. If importation of plague into the United States should
occur, the potential for epidemic spread is low (1,3).
Suspected human plague cases in international travelers should
be reported through state and local health departments to CDC's
Division of Quarantine, National Center for Prevention Services,
telephone (404) 639-8107 or (404) 639-2888 (nights, Sundays, and
holidays). Additional information about plague is available to
physicians and the general public from the CDC Voice Information
System, telephone (404) 332-4555, and to physicians, public health
officials, and laboratory personnel from CDC's Division of
Vector-Borne Infectious Diseases, National Center for Infectious
Diseases, telephone (303) 221-6453.
References
Craven RB, Maupin GO, Beard ML, Quan TJ, Barnes AM. Reported
cases of human plague infections in the United States, 1970-1991.
J Med Entomol 1993;30:758-61.
World Health Organization. International health regulations. 3rd
annotated ed. Geneva: World Health Organization, 1983:26-9.
CDC. Human plague -- India, 1994. MMWR 1994;43:689-91.
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| Erratum: Vol. 43, No. 39
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| SOURCE: MMWR 43(41);763 DATE: Oct 21, 1994
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| In the article "Update: Human Plague -- India, 1994", on
page |
| 723, in the second paragraph of the editorial note, the fourth
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| sentence should read "Under federal foreign quarantine
regulations |
| (2), air passengers who have an illness suspected to be plague
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| (i.e., based on clinical presentation and travel history) during
a |
| flight or at disembarkation are subject to isolation and
transfer |
| to an appropriate diagnostic and treatment facility." The
reference |
| cited in the sentence should be "2. Office of the Federal
Register. |
| Code of federal regulations: foreign quarantine. Washington, DC:
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| Office of the Federal Register, National Archives and Records
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| Administration, 1993. (42 CFR Part 71)."
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